NPIMap

Organization Active NPI

Rad Rheumatology and Autoimmune Disorders

  • Rheumatology Physician
  • Raynham, MA
National Provider Identifier
1114281102
Registry record updated Jun 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
211533 Issued in MA
Legal business name
RAD RHEUMATOLOGY AND AUTOIMMUNE DISORDERS
Practice address
675 Paramount Dr
Suite 205
Raynham, MA 02767-5416
Phone
(508) 822-2874
Fax
(508) 880-0540
NPI assigned
Jun 25, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Marianna Feoktistov
Title
Office Manager
Phone
(508) 822-2874

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RR0500X 211533 MA Primary

Addresses

Primary practice location

675 Paramount Dr
Suite 205
Raynham, MA 02767-5416

Mailing address

675 Paramount Dr
Suite 205
Raynham, MA 02767-5416
Phone (508) 822-2874

Other identifiers 1

IdentifierTypeStateIssuer
9781510MedicaidMA

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340582400000",
    "number": "1114281102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 PARAMOUNT DR",
            "address_2": "SUITE 205",
            "city": "RAYNHAM",
            "state": "MA",
            "postal_code": "027675416",
            "telephone_number": "508-822-2874",
            "fax_number": "508-880-0540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 PARAMOUNT DR",
            "address_2": "SUITE 205",
            "city": "RAYNHAM",
            "state": "MA",
            "postal_code": "027675416",
            "telephone_number": "508-822-2874",
            "fax_number": "508-880-0540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAD RHEUMATOLOGY AND AUTOIMMUNE DISORDERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-25",
        "last_updated": "2012-06-25",
        "status": "A",
        "authorized_official_last_name": "FEOKTISTOV",
        "authorized_official_first_name": "MARIANNA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "508-822-2874",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "MA",
            "license": "211533",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9781510",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raynham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.